Causes of bleeding due to arterial injury after minimally invasive percutaneous nephroclithotomy

Abstract

Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL). Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012, and January 2017, in our hospital. Among them, 1 853 were male and 1 127 were female. Age from17 to 76 years old, average age was (45.7±24.1) years. The calculi size was from 1.5 to 4.2 cm, average of (2.62±1.08)cm. There were 2 478 kidney stones and 502 cases of ureteral calculi. Besides, 727 cases with mild hydronephrosis, 1 971 cases with moderate hydronephrosis, 282 cases with severe hydronephrosis; 480 patients with urinary tract infection; 103 patients with renal empyema or acute renal failure; 63 patients with cardiovascular and cerebrovascular stent implantation; 214 patients with diabetes mellitus. Results In this study, all of the patients were established percutaneous renal tract successfully, indwelling drainage tube (6±2)d, and postoperative hemorrhage in 117 cases, of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury, 5 cases with pseudo-aneurysm, and 4 cases with arteriovenous fistula. However, all these cases were rehabilitated after the treatment of super-selective renal artery embolization. The rates of arterial injury of renal calyx access and pelvic access were 0.39% (10/2 535) and 4.27% (19/445), respectively. The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P 0.05). All the percutaneous renal accesses were dilated with Amplatz sheaths, and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35% (5/1 446), 0.46% (5/1 089), respectively, with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P>0.05). The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98% (5/253) and 7.29% (14/192), respectively. There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P 0.05). Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury. Key words: Percutaneous nephrolithotomy; Rate of arterial injury; Super-selective renal artery embolization; Precise puncture